Intrathecal antibody production in two cases of yellow fever vaccine associated neurotropic disease in Argentina

• Published in: Journal of medical virology Vol. 83; no. 12; pp. 2208 - 2212
• Main Authors: Pires-Marczeski, Fanny Clara, Martinez, Valeria Paula, Nemirovsky, Corina, Padula, Paula Julieta
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2011; Wiley; Wiley Subscription Services, Inc
• Subjects: adverse effects; Antibodies, Viral - blood; Antibodies, Viral - cerebrospinal fluid; Argentina; Biological and medical sciences; cerebrospinal fluid; encephalitis; Enzyme-Linked Immunosorbent Assay; Flavivirus; Fundamental and applied biological sciences. Psychology; Human viral diseases; Humans; Immunoglobulin M - blood; Immunoglobulin M - cerebrospinal fluid; Infectious diseases; longitudinal myelitis; Male; Medical sciences; meningoencephalitis; Meningoencephalitis - diagnosis; Meningoencephalitis - immunology; Meningoencephalitis - pathology; Microbiology; Middle Aged; Miscellaneous; Myelitis - diagnosis; Myelitis - immunology; Myelitis - pathology; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies; Viral diseases; Virology; Yellow Fever Vaccine - adverse effects; Yellow fever virus; Argentina; Tropism; Encephalitis; Nervous system diseases; Antibody; Toxicity; Vaccine; Cerebrospinal fluid; Flavivirus; Cerebral disorder; Meningoencephalitis; Infection; Virus; Viral disease; Arbovirus disease; Central nervous system disease; adverse effects; Flaviviridae; Yellow fever; longitudinal myelitis
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.22236

During the period 2007–2008 several epizootics of Yellow fever with dead of monkeys occurred in southeastern Brasil, Paraguay, and northeastern Argentina. In 2008 after a Yellow fever outbreak an exhaustive prevention campaign took place in Argentina using 17D live attenuated Yellow fever vaccine. This vaccine is considered one of the safest live virus vaccines, although serious adverse reactions may occur after vaccination, and vaccine‐associated neurotropic disease are reported rarely. The aim of this study was to confirm two serious adverse events associated to Yellow fever vaccine in Argentina, and to describe the analysis performed to assess the origin of specific IgM against Yellow fever virus (YFV) in cerebrospinal fluid (CSF). Both cases coincided with the Yellow fever vaccine‐associated neurotropic disease case definition, being clinical diagnosis longitudinal myelitis (case 1) and meningoencephalitis (case 2). Specific YFV antibodies were detected in CSF and serum samples in both cases by IgM antibody‐capture ELISA. No other cause of neurological disease was identified. In order to obtain a conclusive diagnosis of central nervous system (CNS) infection the IgM antibody index (AIIgM) was calculated. High AIIgM values were found in both cases indicating intrathecal production of antibodies and, therefore, CNS post‐vaccinal YFV infection could be definitively associated to YFV vaccination. J. Med. Virol. 83:2208–2212, 2011. © 2011 Wiley Periodicals, Inc.